On Aging: Where you live often determines longevity

There is no city, town, or village named Bangladesh in Texas (although I had to Google it to make sure). But a map of Texas I recently examined put me in mind of that impoverished country we usually hear about only when it is ravaged by a natural catastrophe. Here's why:

You may have heard that a group of noted demographers recently reported that life expectancy, which is a pretty good measure of overall health, varies enormously among Americans, depending on their education level and ethnicity. If the longest-lived group (Hispanic women with a college degree) has a 21st Century life expectancy, the shortest-lived (black males with less than a high school education) exists in the health-equivalent of the 1950s. Note that although Hispanic Americans are on average poorer and less educated than Anglos (wealth and education typically associate with longer life), they are longer-lived. This is the so-called Hispanic Paradox, which no one understands but which it might behoove us here in San Antonio to investigate seriously.

This report sent me scurrying to see how Texans' life expectancy stacked up against the other 49 states. Despite our large Hispanic population, Texas comes in 30th of the 50 states, a little below the national average. No. 50, Mississippi, bless its heart, makes all the other states look good by comparison in life expectancy too.

What may be more interesting than our overall standing among states is the vast health differences within Texas. Topping our list of long-lived Texan counties is Collin County, a suburban retreat just north of Dallas and the only county in Texas to have an overall life expectancy greater than 80 years. In fact, the people of Collin County are longer-lived than those in our longest-lived state, Hawaii. Even the men(!) live more than 80 years.

What's so special about that county? Wealth, for one thing. It's the wealthiest county in Texas and 23rd wealthiest in the country. It's highly educated too, with nearly half of its adults having at least a college degree. I present these facts as if they explained something, but there is less here than meets the eye. While we know that money and education improve health and increase longevity, we're not exactly sure why. Part of the reason seems to be that more educated, wealthier people have, on average, better health habits. They smoke less, are less likely to be obese and are more likely to do some sort of regular exercise. But even when we take these things into account, there is still a further health advantage to being financially secure and well educated. The elephant in this room, of course, would seem to be access to health care, which in this country follows wealth. However, almost the same wealth-health effect occurs in England where everyone has access to the same health-care system. Maybe it's less stress? Fundamentally, we just don't know.

About 100 miles southeast of Collin County but on the exact opposite end of the life expectancy scale, is rural Anderson County. It is not only poorer, blacker and less educated than Collin County, it is poorer, blacker and less educated than the rest of Texas generally. There, the men die 10 years sooner than men of Collin County. A 10-year life expectancy difference is huge. It is the difference between men in the US and Bangladesh. So when I looked at the map of life expectancies in Texas counties, I couldn't help thinking of Anderson as our own little Bangladesh. That is not a happy thought. Maybe someone ought to look into it.